The oral corticosteroid sparing effect of omalizumab in patients with severe chronic asthma: Is there a difference when you become 12 years old?

Abstract

Omalizumab is licensed for treatment of severe persistent allergic asthma over the age of 6 years. In England and Wales, the National Institute of Clinical Excellence recommends omalizumab as a possible treatment for young people over the age of 12, but not for children age 6 – 12.

We describe a population of children with severe asthma who have undergone a 16 week open label therapeutic trial of omalizumab.

The dose of oral corticosteroids at the start & end of the trial was documented. Some children completed modified quality of life and asthma symptom control questionnaires before and after the trial.

To date 15 children (13 boys) age 3-11 years, and 19 children (12 boys) age 11-16 years have completed a therapeutic trial in our centre. The baseline IgE was comparable between groups. We were able to reduce the daily corticosteroid dose in 13 children < 12 years (median pre 20, post 10 mg p<0.01) and in 16 children >12 years (median pre 10, post 5 mg, p<0.01).There was a significant increase pre- to post- trial in documented quality of life, using AQLQ (<12 n=8, >12 n=16), and asthma control (<12 n= 8, >12 n= 15) in all bar 1 patient in each group.

In conclusion, the use of omalizumab in children with severe asthma may result in a clinically significant decrease in the use of oral corticosteroids and an improvement in quality of life and a reduction in asthma symptoms. In our practice omalizumab was as effective in children <12 years of age as in the older age group. A placebo controlled randomised control trial of omalizumab using steroid sparing as primary outcome in a paediatric population is urgently required.